Swiss health vote on knife-edge

When Swiss voters go to the polls in a national referendum on 28 September, the critical issue of private versus public health insurance will likely be decided along the Röstigraben line, the famous psychological divide between German and Latin language cantons.

At least this is according to recent opinion polls, which indicate that German-speaking voters prefer to retain the present system of multiple-choice private insurers, while those in French and Italian-speaking cantons favour a single, public system. Although German-speakers are the majority in Switzerland, those campaigning for a public system have been active in urging a strong voter turnout in Suisse romande and Ticino. This indicates that the outcome is far from certain.

Switzerland’s health system ranks second on a US index of 11 wealthy countries, just behind Britain’s National Health Service (NHS). The US came in last, despite President Obama’s efforts to reform the American system, based in part on the Swiss model. However, out-of-pocket payments in Switzerland are 60% more expensive than in the US and three times higher than the average in the industrialized countries of the Organization for Economic Cooperation and Development (OECD).

Proponents of the current referendum argue that a single, public fund managed by the cantons could save billions of francs by reducing bureaucracy, marketing and advertising costs. Opponents cringe at the spectre of a national monopoly on health care and want to stick with the present system that allows clients to choose among 61 different insurers.

Comparis, a Zurich-based consumer-ranking service noted that Swiss-speaking Germans are largely content with their choice of insurers, while their compatriots in Geneva, Vaud and Ticino feel that they are paying too much for what they get. Insurance premiums are expected to rise in 2015 by 3.8% across the country, according to the Zurich newspaper SonntagsBlick.

The public health campaign has received support from an unexpected quarter, the Geneva Association of Doctors (AMG). Reasons to vote “Oui”, according to the association at a press conference on 28 August, include reducing inflationary premiums, increasing transparency along the lines of the existing fire insurance plans in some cantons and, most importantly, continuing to give patients a choice of doctors and coverage through private supplementary plans.

Many election observers are predicting that this year’s result will mirror a similar vote in September 2010 to revise the law on unemployment insurance, considered sufficient by the Right and inadequate by the Left. The Röstigraben decided that outcome with 53.4% agreeing with the revision. The question now is whether this linguistic and ideological divide will be supplanted by another widening chasm – the city versus rural divide.